1. 1 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 19 Staffing and Scheduling

2. 2 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Staffing  The Joint Commission (TJC) surveys hospitals on the quality of care provided.  TJC does not mandate staffing levels but does assess an organization’s ability to provide the right number of competent staff to meet the needs of patients served by the hospital. (TJC, 2007)

3. 3 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. California Mandated Staffing Guidelines  California has mandatory staffing guidelines  California became the first state in the nation to require mandatory safe licensed nurse/patient ratios in all acute care hospital units.  Enacted in 1999, the legislation (AB 394) requires that additional nurses be added to a minimum ratio in accordance with a patient classification system based on the severity of the patient’s condition.  Nine other states have since enacted legislation and/or regulations: Washington DC, Florida, Illinois, Maine, New Jersey, Oregon, Rhode Island, Texas, and Vermont.

4. 4 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Process of Staffing  Daily staffing refers to filling in open shifts on the current work schedule.  Scheduling refers to making work assignments for the next work period. It is done from 4 to 8 weeks in advance depending on the institution.  The staffing process culminates with a schedule (organized plan) of personnel to provide patient care services.

5. 5 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Scheduling Variables  The number of patients, complexity of patients’ conditions, and nursing care required  The physical environment in which nursing care is to be provided  The nursing staff members’ competency levels, qualifications, skill range, knowledge or ability, and experience level  The level of supervision required  Availability of nursing staff members for the assignment of responsibilities

6. 6 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Four Major Types of Staffing Systems 1. Centralized scheduling—Decision making occurs in a “centralized” location for the entire institution. 2. Decentralized scheduling—Decision making occurs with the nurse manager on the unit. 3. Mixed scheduling—Blends aspects of items 1 and 2. Individual units may manage staffing, but if they cannot fill open shifts, they might forward their needs to a centralized office. 4. Self-scheduling—Individual staff members schedule themselves. The nurse manager then works with staff members to fill empty slots.

7. 7 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Pros and Cons of Centralized versus Decentralized Scheduling Scheduling MethodProsCons CentralizedFairness Cost Containment Lack of individualized treatment DecentralizedManagers have authority Staff get personalized attention Staffing is easier & less complicated Schedule used to punish and reward Time consuming for managers Cost containment is more difficult

8. 8 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Future Scheduling  Pattern scheduling—Staff commit to work a set number of shift types in a given time frame. At the end of the time period, the pattern repeats (such as 3 weeks of day shift followed by 1 week of night shift, repeated every 4 weeks). Pattern scheduling can also include permanent shifts, block shifts, and rotating shifts.  Preference scheduling—Staff define their preference for shift type, days of the week, and unit. Defined rules can override preferences.  Rules scheduling—Based on an organization’s scheduling policies. Because it does not take pattern or preference into account, it is rarely used alone.  Self-scheduling—Scheduling needs are defined, and then staff on a rotating, first-come, first-served basis; sign up for available shifts.

9. 9 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Pros and Cons of Scheduling Types Scheduling TypeProsCons Rules-based Incorporates regulatory issues (hours, time off, overtime, staffing ratios) Does not take preferences & staffing patterns into account Scheduling can be erratic Pattern Predictable schedulesLittle flexibility Impairs recruitment Preference Considers staff needsPreferences may not match rules Self Enables more creativity covering shifts Increased staff satisfaction Saves time for nurse managers less organization and manager control of staffing

10. 10 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Full-Time Equivalent (FTE)  40-hour full-time work week  52 weeks per year  Equals 2080 hours of work time per year

11. 11 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Productive vs Non-Productive Time  Productive = actually working  Non-productive = benefit time (holidays, vacation, sick time, education time)

12. 12 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Part-Time Staff  Broaden horizons beyond home  Increase income  Provide ego satisfaction  Maintain nursing skills  Continue education

13. 13 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Temporary Agency Nurses  Usually a last resort  The staffing agency is a business that has a registry of nurses who have highly flexible schedules  Replacement staff from agency pools are expensive

14. 14 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Travel Nurses  “Travelers” are per diem nurses working for a business that places them in contracted hospitals  Unlike agency nurses, travelers usually sign longer-term contracts with hospitals (3 to 6 months or longer)

15. 15 Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc. Overtime Concerns  Length of time that the nurse will be working.  The nurse manager must be careful to evaluate the exhaustion level of the staff.  There are documented instances of increased errors when the staff is exhausted (Garrett, 2008).  On a budget end, overtime may increase the dollars spent on care provided.  State labor law will need to be reviewed as well as union guidelines. They may define the number of hours required between shifts.